Dennis McAllister, LCSW

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Dialectical Behavioral Therapy (DBT)

Overview of Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others.

Uses

It was originally intended for people with borderline personality disorder but has since been adapted for other conditions where the patient exhibits self-destructive behavior, such as eating disorders and substance abuse. It is also sometimes used to treat post-traumatic stress disorder.

History

DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy alone did not work as well as expected in patients with borderline personality disorder. Dr. Linehan and her team added techniques and developed a treatment which would meet the unique needs of these patients.

DBT is derived from a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when one opposing force is stronger than the other, or in more academic terms—thesis, antithesis, and synthesis.

More specifically, dialectics makes three basic assumptions:

All things are interconnected.
Change is constant and inevitable.
Opposites can be integrated to form a closer approximation of the truth.

Thus in DBT, the patient and therapist are working to resolve the seeming contradiction between self-acceptance and change in order to bring about positive changes in the patient.

Another technique offered by Linehan and her colleagues was validation. Linehan and her team found that with validation, along with the push for change, patients were more likely to cooperate and less likely to suffer distress at the idea of change. The therapist validates that the person’s actions “make sense” within the context of his personal experiences without necessarily agreeing that they are the best approach to solving the problem.

DBT as a Type of Cognitive Behavioral Therapy

DBT has now evolved into a standard type of cognitive behavioral therapy. When a person is undergoing DBT, they can expect to participate in three therapeutic settings:

A classroom where a person is taught behavioral skills by doing homework assignments and role playing new ways of interacting with people

Individual therapy with a trained professional where those learned behavioral skills are adapted to a person’s personal life challenges

Phone coaching in which a person can call their therapist to receive guidance on coping with a difficult at-the-moment situation

In DBT, individual therapists also meet with a consultation team to help them stay motivated in treating their patients and help them navigate difficult and complex issues.

Four Modules

People undergoing DBT are taught how to effectively change their behavior using four main strategies:

Mindfulness—focusing on the present (“living in the moment”).

Distress Tolerance—learning to accept oneself and the current situation. More specifically, people learn how to tolerate or survive crises using these four techniques: distraction, self-soothing, improving the movement, and thinking of pros and cons.

Interpersonal Effectiveness—how to be assertive in a relationship (for example, expressing needs and saying “no”) but still keeping that relationship positive and healthy.

Emotion Regulation—recognizing and coping with negative emotions (for example, anger) and reducing one’s emotional vulnerability by increasing positive emotional experiences.

By Nancy Schimelpfening, Reviewed by Steven Gans, MD

Cognitive Behavioral (CBT)

Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.

CBT can be a very helpful tool in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from CBT has a mental health condition. It can be an effective tool to help anyone learn how to better manage stressful life situations.

Why it’s done

Cognitive behavioral therapy is used to treat a wide range of issues. It’s often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way.

CBT is a useful tool to address emotional challenges. For example, it may help you:

Manage symptoms of mental illness
Prevent a relapse of mental illness symptoms
Treat a mental illness when medications aren’t a good option
Learn techniques for coping with stressful life situations
Identify ways to manage emotions
Resolve relationship conflicts and learn better ways to communicate
Cope with grief or loss
Overcome emotional trauma related to abuse or violence
Cope with a medical illness
Manage chronic physical symptoms
Mental health disorders that may improve with CBT include:

Sleep disorders
Sexual disorders
Depression
Bipolar disorders
Anxiety disorders
Phobias
Obsessive-compulsive disorder (OCD)
Eating disorders
Substance use disorders
Schizophrenia
PTSD

During CBT

CBT generally focuses on specific problems, using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do “homework” — activities, reading or practices that build on what you learn during your regular therapy sessions — and encourage you to apply what you’re learning in your daily life.

Steps in CBT

CBT typically includes these steps:

Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental illness. You and your therapist may spend some time deciding what problems and goals you want to focus on.

Become aware of your thoughts, emotions and beliefs about these problems. Once you’ve identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.

Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.

Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what’s going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won’t take as much effort.

By Mayo Clinic Staff

Emotionally Focused Therapy

What Is Emotionally Focused Therapy?

Emotionally Focused Therapy (EFT) is a short-term form of therapy that focuses on adult relationships and attachment/bonding. The therapist and clients look at patterns in the relationship and take steps to create a more secure bond and develop more trust to move the relationship in a healthier, more positive direction.

When to Use

Couples and families in distress can benefit from EFT and learn to improve their relationships. Often, clients are dealing with anger, fear, loss of trust, or sense of betrayal in their relationship. EFT has also been proven effective for couples who are having trouble coping with their own illness or that of a child. In addition to helping the distressed relationship, EFT can also help reduce individual symptoms of depression or trauma.

What to Expect

An EFT therapist observes the dynamics between clients in the therapy setting, ties this behavior to the dynamics in their home lives, and helps direct new conversations and interactions based on more honest feelings. To accomplish this, your therapist will encourage you to look at your current emotional issues and then help you discover feelings and emotions that you may not realize you have. You may discover deeper past feelings and vulnerabilities that are blocked by the more immediate emotions you display in your current relationship. You will learn to express these emotions in a way that will help you connect, rather than disconnect with your partner or family member. You will learn new ways to listen and stay attuned to another’s emotions and discover more productive ways to respond to emotional situations.

How It Works

EFT focuses on the present time to makes changes in the here and now. There are three steps, or stages, of EFT. The first is to de-escalate the couple’s or family member’s negative cycle of interactions, and help them see and understand what is happening in their relationship. Clients come to see that the problems lie in insecurities and distance. The next stage is to restructure interactions, wherein the therapist helps clients discuss their fears in the relationship, using language that doesn’t push the other away. Clients learn to turn toward each other and discuss their needs and they become more open and responsive to each other. Consolidation is the third stage of EFT, wherein the therapist helps clients see how they got into negative patterns and points out how they were able to change those patterns and can continue these types of conversations in the future.

By Psychology Today